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News > Bulls N' Bears (Sponsored Content)
By Matt Birney
Managing Editor of Bulls N Bears, Matt Birney, writes that history can provide guidance when it comes to just how long it takes the ASX to recover from global health related pandemics. From peak to trough and peak again, the ASX is remarkably consistent after a pandemic and the numbers will shock you. So just what does this mean for this Coronavirus inspired market crash?
Managing Editor of Bulls N Bears, Matt Birney, shares Bulls N Bears' research about how long it normally takes the ASX to recover after a health pandemic related market crash. The numbers will surprise even the most ardent of pessimists.
Are they just soothing words in current times referencing the cyclical nature of markets and history, or merely a wishful sentiment echoing failed portents past now meaningless in a new age of raging fear and financial gloom?
Uber-successful investor Warren Buffet puts it well when he says:"We've mourned the loss of hundreds of thousands of lives though wars, violence and disease. We've witnessed whole industries wither and eventually collapse or suddenly implode. Through it all, the financial markets have always recovered. It might have taken months or recovery may have required years, but it did happen."
There are at least three certainties in life; death, taxes and market rebounds and with respect to the latter (and also the former come to think about it) it is all about timing.
Pre-Corona, global markets were exceptionally robust and the Dow Jones in particular, was trading at an all time high only in February this year. With so many formally revered companies trading at prices that would make a speculator froth at the mouth, it is only a matter of time before the punters and fund managers alike start to drag global indexes skyward – but when ? – that is the question.
The answer to that question will elude many and enrich others that get it right.
But it will take time – In classic Buffet style, the wily investor once said "You can't make a baby in a month, by getting nine women pregnant."
Some consider picking market highs and lows to be an art and some consider it to be a science but casting art and science to one side for a moment, others, perhaps wisely, like to take their lead from the annals of history.
Throughout the ages, history has proven the cyclical nature of markets with unending repetition.
The US banking crisis in the 1790s, the depressions of the 1870's and 1930's, the oil price shocks of the 1970's, the 1987 stock market crash and the Global Financial Crisis of 2008, were all extremes in the history of markets. In almost every case when the dust settled, markets rebounded – and in some cases it didn't take all that long.
Notably the one difference about these crises when compared to current times is the common element that they were all financial crises at heart. Certainly, we are facing a financial crisis today, however, the current financial conditions are more the effect than the cause, with health at the core of today's financial crises.
So lets see if there are any pearls of confidence that can be gleaned from previous health related market falls.
Consider the following: Bird Flu, as measured from March 2013, drove the Australian market down 9 per cent to a trough in June that year before recovering all loses by September 2013 – just 6 months after it started and only three months after the market low. The Zika virus tanked the market by nearly 10 per cent from October 2015 to February 2016. Once again, the recovery back took just three months with the ASX200 regaining all of its losses by May 2016.
Further back, SARs took an 8.5 per cent bite from the ASX in 3 months which then took another 4 months to recover. Worse still was Swine flu in 2009, which, combined with the destructive forces of the tail end of the GFC, managed to drive the Australian market down by nearly 16 per cent from peak-to-trough in just one month between January and February 2009. By April that year however – just 2 months later- the market had regained all of its event-driven losses – A stunning 3 month reversal of fortunes from inception to recovery and only 2 months from the trough to full recovery.
Interestingly Bird Flu actually hit twice with a second wave ripping almost 6 per cent out of the ASX again between November and December 2013 – and the time to recovery for the second wave from the trough ? Three and a half months.
To be clear, what is now casting a pall over financial markets now is unprecedented, but history is still the best guide when it comes to making decisions on these matters.
COVID-19 struck when markets were running up all-time highs and credit was in easy supply. Since the market highs of early February this year, equity markets across the globe have experienced the sharpest bear correction in the history of exchange-traded securities, courtesy of Coronavirus. It could be argued the crash of 1987 was sharper, as equity markets lost 25 per cent in a day but history-making rallies were recorded in the subsequent days. True, the full recovery took almost 2 years on that occasion, but markets subsequently launched into the heady investment days of the 1990s when US stocks for example, more than tripled in value. The Dow vaulted from just above 5000 in January 1990 to a December 1999 peak above 17,000.
Warren Buffett says that we, as humans, are social beings evolved to follow each other and to conform. Furthermore, the urge to follow the crowd creates volatility because panic and fear are contagious - much like the current virus. As panic spreads, so does uncertainty and the madness of the mob takes reign. Buffett called it Groupthink, or herd mentality and when this pervades it's time to swim against the tide he says. The road less travelled, as Robert Frost would say.
Buffett has been very clear to say that COVID-19 is a big deal. It is serious – deadly serious – and his firm has taken extreme measures to cope. Anyone not experiencing stress or anxiety is simply being irrational.
But Buffett added his view that while history does not necessarily repeat itself, there are always trends to highlight how people have dealt with and triumphed over all manner of crises.
He said; "If you look at events that investors responded to with fear over the last 100 years, you will see similar spikes to what we see now during the 1918 Spanish flu outbreak, the Oct 29 1929 stock market crash and Great Depression, the second World War, and the conflicts that followed in Korea and Vietnam."
According to Buffet, even if recovery is not imminent it is at least inevitable, but it does take time.
Every time we see a market crash, the doomsdayers tell us that this one is unlike any crash before – thay say it is deeper and more severe than we have ever seen before and we may never recover – but we always do.
Curiously though, it could easily be said that this Coronavirus inspired crash is most certainly deeper and more severe than we have ever seen before so does this new league of crash mean that we will never fully recover and does it make a mockery of the historic 2 to 3 months to recovery that we have seen in previous health related crashes ?
Can we look to the fact that there were no underlying financial issues hanging around before this crash to bask in some level of manufactured comfort ?
When the Governments of the world get a handle on the spread of Coronavirus - or better still – find a cure for it, can we safely predict that markets will come roaring back ?
On that note, there are a number of poorly publicised trials out there of a little known and readily available anti-Malaria drug known as "Hydroxychloriquine" that have produced some stunning reversals of Coronavirus – some, like the 40 person trial in the South of France, produced a 100% success rate.
Whilst the main stream media are loathe to give these small sample trials too much air-time right now, a very large trial in New York has recently kicked off and the results of that trial could put a fire under markets like we have never seen before.
A cure ? Could it be real ? Could it be imminent ?
If the small sample trials are anything to go by the answer could well be yes – and just remember you read it here first – Hydroxychloriquine could be the saviour of our world as we know it, but that is news for another day.
There have been 37 equity market declines of more than 10 per cent since 1950. The average of peak to trough decline lasted 3.5 months and every decline was completely erased by subsequent bull market rallies.
There are some general rules – some say clichés – that the majority of professional market traders have always considered carefully. Manage your risk, don't average down, trade tight stop-losses and ride the trend remembering always the trend is your friend – that is until the bend.
Considering current market gyrations these principles clearly still hold true. Not trying to pick bottoms is another rule – but perhaps best left to one side for now.
The question of whether to sell now or wait on the expectation that markets will rise from the ashes again, just like they did in all of history, is best left to your professional advisers, but in considering this question we can again look to Buffet for some inspiration.
He once said: "We simply attempt to be fearful when others are greedy and to be greedy only when others are fearful."
The greater question now is, are you fearful, greedy or just plain over it ?
Matt Birney is the Managing Editor of ASX listed company financial news media outlet, Bulls n Bears.
Return to Bulls N Bears for more public company news
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Home Alzheimer's Disease
This Common Skin Condition Could Be Linked to Alzheimer's
Lauren CahnUpdated: Sep. 17, 2020
Could an extremely common virus raise your risk of developing Alzheimer's disease? Here's what you need to know.
toysf400/Shutterstock
Alzheimer's disease is tragic: This deadly, irreversible brain disorder slowly destroys a person's memory, thinking skills, and the ability to carry out simple tasks, according to the National Institutes of Health. Not only is there no cure, but no one knows why the disease attacks the brain in the first place. Now a study suggests that common herpes viruses may be linked to Alzheimer's.
Researchers have long suspected that there may be a connection between dementia and herpes simplex virus 1, or HSV-1, which causes cold sores, or fever blisters. In an attempt to find new ways to use drugs to treat Alzheimer's, scientists, including experts from the Icahn School of Medicine at Mount Sinai in New York City and Arizona State University in Phoenix, analyzed nearly 1,000 brains from brain banks around the world. Their results, published in the journal Neuron, indicate a strong connection between Alzheimer's and the herpes viruses responsible for the childhood rash roseola: HSV-6A and HSV-7.
Herpes can lie dormant in the body for decades, and having a herpes infection doesn't guarantee you'll get dementia, the researchers note. Some people may carry a genetic susceptibility to Alzheimer's, the virus or both, leading to brain deterioration. The researchers also point out that their results show only a link between herpes and Alzheimer's.
Other recent findings underscore the importance of exploring the herpes-Alzheimer's connection: In a study published earlier this year in Neurotherapeutics, Taiwanese epidemiologists found that people infected with HSV-1 had three times the risk of developing Alzheimer's later in life compared with those who were virus-free. Even more remarkable, the researchers found that infected patients who sought antiviral treatment (using drugs like acyclovir) cut their risk of Alzheimer's by a factor of ten. In a commentary on the study, scientists at the universities of Manchester and Edinburgh say that the results raise the possibility that antiviral drugs—and potentially vaccinations—may offer protection against Alzheimer's.
The findings are compelling; while we wait for researchers to confirm the results, take care not to fall for these 15 myths about Alzheimer's disease.
Originally Published: August 21, 2018
Lauren Cahn
Lauren Cahn is a New York-based writer whose work has appeared regularly on Reader's Digest, The Huffington Post, and a variety of other publications since 2008. She covers health, fitness, yoga, and lifestyle, among other topics. An author of crime fiction, Lauren's book The Trust Game, was short-listed for the 2017 CLUE Award for emerging talent in the genre of suspense fiction.
What Brain Experts Think About the Controversial New Alzheimer's Drug
This Man Battled Dementia for 20 Years Before Finding a Solution

redpajama_set_name: RedPajamaCommonCrawl


Langthabal is at a distance of 9 km from Imphal and provides an insight into the glorious history of Imphal. Standing tall on a hill Langthabal revels in the glory provided by the aura of the relics of the historical palace, traditional dwellings and architecturally complex and accomplished temples of importance.
The place is set within the corridor created due to symmetric jackfruit and pine plantations. The Langthabal surroundings are pristine and the historically important monuments are being preserved well by the archaeology department. The hill housing Langthabal overlooks the Manipur University campus and presents a mesmerizing view of the surroundings.


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Home Products 1841 Melbourne Panoramic Drawing
1841 Melbourne Panoramic Drawing
MP_1001_A4
One of the earliest panoramic drawings of Melbourne as it appeared in 1841, drawn from the original Scots' Church on the corner of Russell and Collins Streets.
This 3-part image was engraved by Alfred Martin Ebsworth in 1889, and was published in the Supplement to "The Australasian Sketcher," April 18, 1889.
This is based upon 3 panels from a 10-panel panorama sketched by Samuel Jackson (1807-76), architect of the first Scots' Church, drawing from its walls, then under construction in 1841.
Notes from the State Library state that this is a "View across Collins-street (between Russell and Swanston streets), looking towards the Yarra and Hobson's Bay -- View down Collins-street to the summit of the rise at William-street, Little Collins-street showing on the right -- View of the City westwards and northwards towards Flagstaff-Hill. Swanston-street beyond buildings in foreground and Elizabeth-street in middle distance."
This is a digitally retouched reproduction of the original held by the State Library of Victoria. All prints are reproduced without the HOTPRESS watermarks.
Our team of conservators are working on a high resolution digital image in order to remove blemishes and artifacts such as stains, mould, scratches and damage caused by the handling of the original. We strive to provide authentic representations of the original work that are suitable for enlargements that retain the tones and character of the original.
Collections: Melbourne - Collins Street, Melbourne 1840-1860, Melbourne Panoramas
Category: Collins Street, Melbourne 1840-1860, Melbourne Panoramas
1836 Melbourne Painting from $18.00
1836 Melbourne Painting
This is a reproduction of a painting of Melbourne as it appeared in 1836. The painting is the work of R. Hoffman and the lower...
Print Size Print Size: D - 135mm x 420mm - $18.00 Print Size: C - 191mm x 594mm - $26.00 Print Size: B - 271mm x 841mm - $34.00 Print Size: A - 383mm x 1189mm - $55.00
1838 Melbourne from the south across the Yarra from $16.00
1838 Melbourne from the south across the Yarra
PLEASE NOTE: The dimensions of these prints may require special framing. An image of Melbourne as it was in 1838, looking from the south bank...


Our Philosophy – We believe in mindful and efficient use of money and resources. We wish to experience more of the world, live simply and minimise our environmental impact. Many aspects of mainstream society contradict our philosophy. We value alternative lifestyles that encourage personal, active engagement with the world to create positive change.
NOMADS – a life of cheap/free travel is an online community for sharing ideas & information on low-budget/moneyless/low-impact ways to sustainably live on the road.
It all began in August 2013 as a Facebook group, which is still very much the heart of the community today.
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If you are interested in creating something for NOMADS, whether an article or video, please read our submission guidelines and get in touch.
I'm excited about the potential to connect, inspire, share, inform and entertain here.
hey folks, i dig the blog/twitter and what you're doing with the nomads gathering! i'd like to keep up with you a bit more, especially with the stories being posted here to the blog. might i suggest you install the email signup plugin that's part of the wordpess jetpack suite? it let's folks sign up to be notified via email when there's a new post (which is generally easier than rss and all that). anyways, keep rockin!
Thanks for the input and support, Matt! We're big supporters of what you've built at squattheplanet.com.


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How can French Muslims be freed from political Islam?
Ahmed Nadhif Thursday 12 November 2020
The recent terrorist attacks in France, following the latest round in the country's offensive cartoon saga that feature the Prophet Mohammad, and the subsequent Turkish involvement on the scene, have stoked the flames of the discourse of extremism, whether from the French extreme right or from political Islamic groups who appropriate the role of custodian of Muslims and Islam alike.
On the other hand, the huge silent mass of French Muslims, who number about 5 million according to official numbers – and up to 8 million unofficially – struggle where political Islamic groups try to represent them in the face of French right-wing rhetoric.
In the midst of all this, French President Emmanuel Macron's administration is trying to hold the middle ground, while remaining unable to pinpoint the real disease. In his latest speech given during the memorial of history teacher Samuel Paty, Macron said that Islam "is suffering from a crisis." On other occasions, he described it as a crisis caused by extremist Islamic currents, proposing solutions to overcome this crisis.
But, the real question remains: To what extent are any government policies able to overcome this crisis? When trying to answer that question, we must take into account that these policies stem from an authority whose secular principles prevent it from interfering in religious affairs, negatively or positively, in the face of large swaths of Muslims and Islamists who firmly believe in the existence of a "conspiracy against Islam" as part of the mentality of conspiratorial interpretation of history inherited from nationalist currents that have characterized culture and thought in the Islamic world for decades.
However, any attempt to overcome the crisis or "reform Islam" in France in Macron's words, must start from three considerations, or reach them in conclusion:
Firstly, we must believe – contrary to the French right-wing rhetoric that Islam is incompatible with the principles of secularism and republicanism – that Islam, like other religions, is capable, in belief, text, and rituals, of full conformity and harmony with the values of secularism, republicanism, and modernity. Accordingly, we must strive to present a new reading of Islam, far from political Islam's attempts to monopolize or the French right's attempts to stigmatize it as inherently backward. This must be done through a range of research and media programs, not just relying on the security approach. The time has come to stop considering the French Muslim file as a security file that is handled by Ministry of the Interior alone.
Muslims 'not persecuted' in France, says French Muslim Council after Erdogan remarks
Facing Muslim anger, France warns citizens abroad to take caution, avoid gatherings
Secondly, in light of the terrorist attacks taking place today – which are totally condemned in any way and shape – as well as official policies that seek to reform Islam and move it out of its "crisis," and the intransigence of political Islam groups who cry conspiracy at every turn, we believe that Islam is definitely going through a crisis. But it is not a crisis of religion as much as it is a crisis of religiosity. That is to say, it is a crisis of Muslims who have been taken hostage by the groups that claim to represent Islam in France who leverage it for their political agenda without regard to the credo of Muslims and their individual beliefs. Therefore, any reform attempt must be centered around the idea that the solution to this crisis cannot be imposed in a top-down way by the state – as the Sarkozy administration did when it formed the French Council of the Muslim Faith based on sectarian and ethnic quotas – but rather a grassroots approach from the general Muslim populace. These groups must no longer be allowed to claim to represent them and speak on their behalf, requiring an unprecedented effort to spread awareness among the Muslims of France using a panoply of means and methods.
The battle that revealed the real extremist
An attempt to understand Europe and France
Adding injury to insult
Third, and based on the first consideration of presenting a new reading of Islam that is consistent with the values of secularism and republicanism, as well as the second consideration of liberating the general population from the domination of political Islam groups, the task of liberating French Islam from foreign loyalties will be a key goal of any reform program. Unlike the case in Muslim countries, Islam in France is not purely French. Rather, it has become a tool in the hands of countries that want to play with the beliefs of Muslims to achieve political interests inside France or to fight wars with France. Perhaps the example of Turkish involvement today is the greatest evidence of the extent of penetration happening within the French Islamic fabric. Ethnic communities and sects have become mere pawns of countries' foreign policies, which is completely inconsistent with the principle of freedom of faith, on the one hand, and the principles of citizenship and integration on the other. Unfortunately, government policies to organize Islam in France over the past years have entrenched this division among influential countries, claiming separation of church and state, but in the process enabling intervention by other countries. The French Council of the Muslim Faith has thereby been transformed into a congress in which states are represented through organizations and associations that support them with money and training programs. This division threatens to pervade the Muslim population and constitute a barrier to any integration process into French society.
This article was originally published in, and translated from, Lebanese news outlet Annahar al-Arabi.
Last Update: Thursday, 12 November 2020 KSA 15:57 - GMT 12:57
Coronavirus: France's new COVID-19 deaths up by 472; 31,477 hospitalized patients
France's Macron says terrorism threat requires re-think of open-border Schengen
European leaders weigh terrorism strategy after attacks in France, Austria
Coronavirus: France's COVID-19 hospitalizations closing in on April record


RENTAL - Palos Verdes Ballet Company Presents "The Nutcracker"
Palos Verdes Ballet's talented pre-professional dancers will dance in the snow and candy caned stage with guest artist Priit Kripson from the Royal Ballet of Flanders and Stephan Azulay from Canada's Royal Winnipeg Ballet. Pritt Kripson will portray the role of the magical and mysterious "Dr. Drosselmeier", while Stephan Anzulay will sweep away "Marie" to the Land of Sweets where the loving couple will dance the renowned "Grand Pas de deux".
Founded in 1955, Palos Verdes Ballet is the oldest established classical ballet company in the South Bay, with an extensive history and reputation for creating talented, strong classical ballet dancers. For more information on how to become a part of the ballet legacy of the only exclusive classical ballet studio on the Palos Verdes Peninsula, please call 310-377-6663. Additional information is also available at www.palosverdesballet.org.


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If you did not register for classes during New Student Orientation, you can register online for classes.
Pay your tuition and fees by the required due date. You can pay online or at your campus Welcome Center.
Purchase your books online or at your campus bookstore.


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Home2022January06 (Thursday)
January 6 Anniversary: AG Garland Vows to Go After More Protesters at the Capitol, Ignores Leftist Criminals
January 6, 2022 Tucker Carlson and Gateway Pundit 2
Tucker Carlson pointed out that AG Garland failed to mention actual criminals, such as the pipe bomber who was using a phone, which is traceable. Ray Epps, who encouraged riots and crime on video, was taken off of the FBI list.
Pfizer Trial Data Shows Jab Caused Severe Fever in 1 Out of 5 Children
January 6, 2022 Newswars 2
Fevers were observed in the higher dosage 10-microgram dose of mRNA, but it has still been approved by the FDA and CDC for children aged 5 to 12. All of this despite children having an extremely low risk of dying from Covid complications.
Unvaxxed Aussies Told They Won't Be Allowed to Exercise or Go to Work
January 6, 2022 Summit News 2
Unvaccinated Australians in the Northern Territory have been put under a new lockdown. The rules are being introduced despite the fact that across the entire territory, only 23 people are in hospital with COVID-19 and just two are in the ICU.
Georgia Ballot Trafficking Whistleblower Admits to Making $45,000 for Stuffing Ballot Boxes
January 6, 2022 Gateway Pundit 1
The whistleblower was just one of 242 alleged ballot traffickers identified by the True the Vote investigation. There is a possibility that hundreds of thousands of ballots were stuffed into the ballot boxes in Georgia where it is illegal to harvest ballots.
Verizon and AT&T to Roll Out 5G on January 19 after FAA Requests Delay
January 6, 2022 CNet 0
The carriers are set to use frequencies from 3.7 to 3.98GHz, but the aviation industry argued those radio airwaves may interact with instruments like altimeters that use the 4.2 to 4.4GHz ranges. Carriers agreed to lowering tower power levels nationwide with even stricter limits around airports.
France: Rebels Reported to Be Destroying 5G Networks
January 6, 2022 Principia-Scientific, World-Signals and Lifesite News 4
A pair of Capuchin French friars were arrested in September 2021 by police for allegedly trying to set fire to a relay 5G antenna near the town of Ancy. The report says that the mainstream media have been largely avoiding any mention of what is happening, for fear that it will spread even further.


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Q: Intensity Of Sound I know that intensity of sound at a distance 'r' from the the source of sound is given by the equation (i) in the image. Also the second equation gives the wave intensity, but at what point or distance from the source this intensity is??
*As we can see the every term in the equation (ii) remains constant and not change with the distance.

redpajama_set_name: RedPajamaStackExchange


With the local plan strategy, which was adopted in July 2017, allocated sites for development and employment land in the Key Service Centres (i.e. the main towns), the council is now in the position of identifying further non-strategic sites for development, including housing, and there will be a consultation process starting September 5th.
Councillor Craig Browne said "Whilst the proposed housing allocation is slightly lower than expected and may yet fall further by the time a final version of the document is sent to the inspector, the proposed locations still represent a significant challenge for us if we are to ensure that the necessary investment in parking and green infrastructure is to be delivered concurrently. I would strongly encourage all residents to register their views via the official consultation portal."
1. 2 hectares of safeguarded land means land set aside for 300 houses At 150 per hectare.
2. Add 10 houses on a proposed site that is in Wilmslow plus 200 on Sagars Lane, also in Wilmslow but allocated to Handforth and the 900 required for Wilmslow becomes 1110.
3. As of 30th July this year the number of houses committed to Wilmslow in this Plan Period is 1111 - allocated plus windfall. So windfall since 2010 is worth calculating for Alderley Edge.
Have a go at objecting. By 2030, given windfall and a lower than estimated population growth rate, many more houses are being planned for than are actually required.
Just a comment on the figures in point 1 above.
30 dwellings per hectare is the basis for calculating land required. According to various government issues, this is the minimum figure for build in the range of 30-50 dwellings.
By way of example, the draft proposals for the Handforth Growth Village are in this range.
Whilst I appreciate your concern regarding Wilmslow, I must correct your first point as it is likely to cause unnecessary alarm to residents of Alderley Edge.
Site ALD2 (which is being proposed for development of 75 dwellings) is 2.2ha in size, working out at an average of about 34 dwellings per hectare. Site ALD3 (which is being proposed as safeguarded land) is slightly smaller at 2.0ha in size and therefore highly unlikely to provide for the number of dwellings you are suggesting.
Nowhere is it suggested that any site in Alderley Edge could provide a housing density of 150 dwellings per hectare; indeed, you would do well to achieve that in central Manchester.
I do, however, agree with you that CEC are giving more thought to the allocation of housing than they are to the allocation of resources for the supporting infrastructure. This is something that we are trying to address locally through our Neighbourhood Plan.
Apologies to all. Getting my facts wrong on housing per hectare. Craig Browne and Rod Menlove are correct. I guess I am becoming neurotic about what might happen to the land locked between the village and the A34 bypass in due course. Also, the way in which a Local Plan removes from the Green Belt more land than is required to meet a calculated need without due regard to precise mathematics. The Wilmslow figures illustrate quite clearly what can happen.
Thanks for raising this, as I suspect the term "safeguarded land" is likely to cause quite a lot of confusion. Safeguarded land is effectively land which is set aside in the SADPD to meet longer-term development needs, stretching beyond the period of the current Local Plan. It is designed to avoid the need for further reviews of the green belt, before 2030.
Safeguarded Land is not allocated for development within the SADPD and although it is removed from the green belt, the land is still considered open countryside. Planning permission for permanent development on safeguarded land should only be granted following a review of the Local Plan, which proposes the development.
A review would be most likely to do this if Cheshire East were not able to demonstrate a five-year housing land supply, in which case safeguarded land might be considered for development; however, once our Neighbourhood Plan is in place, CE's housing land supply would have to drop to three years, providing us with an extra layer of protection.
I will be holding my community surgery at the library, this Saturday morning (from 10am) and will bring with me the most recent version of Story Homes indicative masterplan.
Emma, living next to 'Safeguarded Land' is akin to a death sentence in an American State Prison. You keep appealing for years intervening sentence and penalty being carried out.
The clue is in the Homes bit of Story Homes. I lived on Adlington 'these fields will never be built on' Road. They were built on. That was 'Safeguarded Land' which should read Target Land for next development near you.
So, just when you think that land is fully safeguarded, along comes a developer with a nice little application, who manages to convince the Planners and the NPC that it is a necessity and is low impact etc. The NPC approve the plans with specially defined conditions and you believe that you are safeguarded once again. Then the developer approaches a Planning Officer, who, without consultation,overturns the limiting conditions. Is any land ever fully safeguarded?
Not much in the way of affordable housing will be built I fear, this will always be a deal to favour greedy developers who bully and cajole to get their own way. Look at what happened to the Royal Oak site. Villagers were told that green spaces and hedgerows plus venerable ancient trees would be preserved and 2 weeks ago an ancient tree (with a tpo)was hacked down on that very site. Everything is overruled by appeal . If one has enough money and brass neck to go to appeal it will always work in the appelant's favour eventually. Look at the amount of high end development goung on at the moment. Builders and developers are motivated by one thing...greed. they do not give a hoot about concerns of residents. Traffic is blocked (look at the mess on the roads in Congleton and Holmes Chapel all caused by large scale developments.) We have total road closures at the drop of a hat to cater to the needs of builders on one luxury development (i.e Hough Lane). Roads which crumble away and deteriorate under constant heavy plant vehicles (Macclesfield Road) are not resurfaced and restored by said developers. It is we the council tax payers who contribute to the scant funds in Highway coffers. There is zero planning for extra capacity in our amazing "bursting at the seam" local schools or Hospital. Front line staff have to deal with the results of greed and bad planning. Why are these same greedy developers not improving the roads and building new schools and hospitals? This should be part of the the conditions set before any new planning granted.
There are plenty of "brown field" sites in Macclesfield and we SHOULD NOT be building and tarmacing our green spaces.
Well said, Tony Haluradivth ……. I totally agree with your views.
The builders / property speculators should be made to repair / resurface all roads and paths leading up to their newly-built properties when agreement is given that they can build there.
This should be insisted upon when drawing up contracts with the builders & Cheshire East.


Today, A lot of work on the tiger design! Some nice play, feeling, testing time with the machine! And some time to draw another quick sketch for one of the Flowers for the Orchid back piece! Here colour study! That's it for today!


Träslövsläge was one of 64 clubs from Sweden that had teams playing during Göteborg Cup Innebandy 2018. They participated with one team in Flickor 15 (02).
In addition to Träslövsläge, 12 other teams played in Flickor 15 (02). They were divided into 3 different groups, whereof Träslövsläge could be found in Group C together with Åstorp/Kvidinge IBS ÅKIBS, FBC Lerum and Värnamo IK.
Träslövsläge continued to Slutspel after reaching 4:th place in Group C. In the playoff they made it to 1/4 Final, but lost it against Åstorp/Kvidinge IBS ÅKIBS with 1-2. In the Final, Pixbo Wallenstam IBF F02 won over Tunet IBK J15 and became the winner of Slutspel in Flickor 15 (02).
Träslövsläge comes from Träslövsläge which lies approximately 75 km from Göteborg, where Göteborg Cup Innebandy takes place.


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Q: How to update your iOS app using Cordova without supporting arm64 or having iPhone 6 I'm developing an iOS app using cordova on ARMV7 architecture because I'm using a couple of plugins that doesn't support ARM64 yet.
The problem that I can't upload the update, because iTunesConnect asks me to upload 4.7-inch and 5.5-inch which are iPhone 6 and iPhone 6 plus. And at same time, I can't run my app on iPhone 6 simulator on Xcode because it must supports ARM64 to run.

A: Simply, use the power of Cordova command line tools, run the simulator, save your images and then upload them to iTunesConnect.
Here's how to use Cordova command line tools
https://stackoverflow.com/a/22329264/183982
Also, make sure if you are trying to test on iPhone 5S, iPhone 6 or iPhone 6-plus, Xcode won't work because your app must support ARM64, so make sure to disconnect your mobile phone if it is iPhone 5s or newer.


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PennFuture reacts to House Bill 1100 being sent to Gov. Wolf
On March 18, PennFuture issued the following statement in reaction to the state Legislature sending House Bill 1100 to Gov. Tom Wolf.
"At a time when the COVID-19 pandemic is gripping our Commonwealth and the nation, and at a time when our elected leaders should be working solely to keep Pennsylvanians safe and reassured, they instead acted on behalf of the fracked gas and petrochemical industries by offering billions in taxpayer handouts," said Jacquelyn Bonomo, President and CEO of PennFuture. "The legislature waited weeks to send its fracked gas bailout bill to the Governor in an effort to give its proponents maximum time to build political pressure for its passage. Now, they've moved the bill in the midst of a national health crisis when the public is rightfully distracted. Think about where the legislatures' priorities are: they're asking the Governor to spend billions more in taxpayer handouts to fossil fuel facilities that will cause more respiratory disease rather than invest in an aggressive response to a pandemic that is harming those with underlying health conditions the most. It's craven politics at its worst."
For more information, please contact PennFuture Director of Media Relations Jared Stonesifer at stonesifer@pennfuture.org or at 412-443-4466.


This comic closes the Hot Guy series, though we certainly haven't seen the last of him. As I've already ranted said my piece regarding this particular trope, I'm taking my commentary here in a different direction instead.
Contrary to popular perception, it's okay to blush.
I am pale-skinned, of the pasty, burns-but-doesn't-tan variety. This means that, in addition to having to avoid the sun like a vampire, I get to exhibit any emotional discomfort in full, vibrant display. At the slightest embarrassment, or confusion, or self-consciousness, my whole face turns pinky-red.
It clashes with my hair. I hate it.
And that philosophy has served me well ever since.
As it turns out, blushing is connected to our fight-or-flight reaction and is 100% uncontrollable… unless you want to have a few little nerves in your spine snipped to end the problem, that is. It's called an endothoracic sympathectomy. (You can read more about it and the science of blushing HERE.) Surgery's not so much my thing, but I can understand why others might lean that direction. Modern culture reveres a calm and stoic demeanor. Showing emotion indicates weakness, and blushing is the ultimate emotional cue. You can fake a smile. A blush, not so much.
And that, perhaps, is the very reason we should cherish this particular bodily quirk. Our instincts warn and preserve us. They indicate when a situation is off-kilter. If I'm blushing, it means something in my immediate environment is out of alignment with my sense of normal. If someone else is blushing, it means the same for them.
It's a brilliant social cue, in other words.
Characters who blush reveal something not just about themselves, but about the world around them: its rules, its restrictions, its social structure. Tempted as I am to make my characters cool and always in control, I'd be forfeiting a valuable communication tool in the process.
So let 'em blush, I say. I mean, I certainly don't create whole worlds so my characters can be comfortable.


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Detroit 5, L.A. 0: Verlander loses no-hit bid in ninth
On a 97 m.p.h. fastball to lead-off the ninth, Chris Iannetta doubled on a 2-2 pitch off the chalk line in leftfield
Detroit 5, L.A. 0: Verlander loses no-hit bid in ninth On a 97 m.p.h. fastball to lead-off the ninth, Chris Iannetta doubled on a 2-2 pitch off the chalk line in leftfield Check out this story on Freep.com: https://on.freep.com/1EjeL8K
Anthony Fenech, Detroit Free Press Published 3:29 a.m. ET Aug. 26, 2015 | Updated 1:12 a.m. ET Aug. 27, 2015
The right-hander reflects on what went well Wednesday at Comerica Park and how it fits into his recent career arc. Video by Anthony Fenech/DFP
Tigers pitcher Justin Verlander reacts to giving up his first hit a double by Angels catcher Chris Iannetta in ninth inning on Wednesday at Comerica Park.(Photo: Diane Weiss DFP)
It felt like Comerica Park in 2007, with Justin Verlander on the pitcher's mound and befuddled hitters in the batter's box, one after another, stepping in and stepping out with weak out after weak out. Back then, he was a sophomore.
It felt like Rogers Centre in 2011, with Verlander standing out there and sitting those hitters down with mid-90 m.p.h. fastballs in the early innings, then high-90 m.p.h. fastballs in the later innings. Three up, three down. Then six. A walk. A double play. Then nine down.
Then 12, 15, 18, 21. Back then, he was in his prime.
Free Press sports writer Anthony Fenech reviews just how good Justin Verlander was Wednesday at Comerica Park. Video by Anthony Fenech/DFP
Tigers 5, Angels 0
Tigers catcher James McCann congratulates pitcher Justin Verlander after pitching a one-hitter in the Tigers' 5-0 win Wednesday at Comerica Park. Diane Weiss DFP
Tigers pitcher Justin Verlander reacts to giving up his first hit, a double by Angels catcher Chris Iannetta, in the ninth inning of the Tigers' 5-0 win Wednesday at Comerica Park. Diane Weiss DFP
Tigers pitcher Justin Verlander waves to the crowd's applause as he leaves the field after his postgame interview after losing a no-hitter in the ninth inning of the Tigers' 5-0 win Wednesday at Comerica Park. Julian H. Gonzalez DFP
Tigers catcher James McCann watches as pitcher Justin Verlander gets a big hug from Alex Avila in the handshake line after Verlander's one-hitter in the Tigers' 5-0 win Wednesday at Comerica Park. Julian H. Gonzalez DFP
Tigers shortstop Jose Iglesias squeezes first baseman Miguel Cabrera arm at the dugout steps after Cabrera hit a two run home run in the fifth inning Wednesday at Comerica Park. Julian H. Gonzalez DFP
Tigers rightfielder J.D. Martinez hits a lead off double in the fourth inning Wednesday at Comerica Park. Julian H. Gonzalez DFP
Tigers first baseman Miguel Cabrera hits two-run home run in the fifth inning Wednesday at Comerica Park. Julian H. Gonzalez DFP
Tigers leftfielder Rajai Davis greets first baseman Miguel Cabrera at home plate after Cabrera's home run scored both in the fifth inning Wednesday at Comerica Park. Julian H. Gonzalez DFP
Detroit Tigers' Nick Castellanos getting congratulations in the dugout after he hit a solo home run in the second inning for a 1-0 lead over the Los Angeles Angels on Wednesday, August 26, 2015, in Detroit. Julian H. Gonzalez, DFP
Detroit Tigers' Ian Kinsler hits a triple in the first inning against the Los Angeles Angels on Wednesday, August 26, 2015, in Detroit. Julian H. Gonzalez, DFP
Detroit Tigers' Victor Martinez strikes out to end the first inning with a runner at third base against the Los Angeles Angels on Wednesday, August 26, 2015, in Detroit. Julian H. Gonzalez, DFP
Detroit Tigers' Justin Verlander pitching in the first inning against the Los Angeles Angels on Wednesday, August 26, 2015, in Detroit. Julian H. Gonzalez, DFP
Los Angeles Angels' Hector Santiago pitching in the first inning against the Detroit Tigers on Wednesday, August 26, 2015, in Detroit. Julian H. Gonzalez, DFP
Detroit Tigers' Nick Castellanos hits a solo home run in the second inning for a 1-0 lead over the Los Angeles Angels on Wednesday, August 26, 2015, in Detroit. Julian H. Gonzalez, DFP
Sometime during Wednesday night's game against the Angels – maybe the fourth inning, maybe the fifth – manager Brad Ausmus started chewing barbecue sunflower seeds. He didn't stop. He was standing in the same spot. He didn't move.
It was in the eighth inning when rightfielder J.D. Martinez finally found out why the 31,938 at Comerica Park were standing and screaming and after a double play in the seventh inning, "When everybody started freaking out," and he looked at the scoreboard, then at Verlander's pitch count, the line score above and, "Oh, no," he thought to himself.
Verlander was closing in on a no-hitter.
Now, in 2015, Verlander is a wily veteran. He has reached the highest of highs in his 10-year career and last year, by his standards, fell to the lowest of lows.
But on this night at Comerica Park, after a six-start stretch to reassert his dominance at the top of the Tigers' rotation, he, for at least one night, nearly climbed back on top of the major league mountain of starting pitchers with by nearly throwing his third career no-hitter in a 5-0 shutout of the Angels.
"Obviously," Verlander said, "Luck always has to be a little bit on your side."
And on a 97 m.p.h. fastball to Chris Iannetta in a 2-2 count to lead-off the ninth inning, it wasn't, when the Angels catcher doubled off the chalk line in leftfield – half on, half off, third baseman Andrew Romine saw from his vantage point – breaking up Verlander's chances to join the likes of boyhood idol Nolan Ryan, Sandy Koufax, Bob Feller and Cy Young with three or more.
"I threw what I wanted," he said. "I just didn't locate it. It was the only ball all night I threw over the heart of the plate."
And after the hit, after he said, "Beep!" to himself on the mound – Verlander censored himself so the producers behind the television cameras didn't have to – the veteran Tigers' right-hander reflected on what this, standing on a mound with a baseball in the ninth inning of a no-hit bid after all of the ups and downs, meant to him.
"I hadn't been through a tough time in my career yet," he said. "This has a special meaning because of the way the fans were treating me and reacting and I know they've wanted to see me back just as bad as I have and really, from the sixth inning on, they were up."
Goosebumps is what he felt after a seventh inning double play off the bat of Erick Aybar, which erased his second walk off the game – another double play eliminated his first to Ryan Jackson in the third inning – and in control is how he felt from the outset, using his fastball command first and foremost and then his off-speed stuff when he needed it, most notably on the twin killings.
"He was outstanding, he really was," Ausmus said. "Over the last seven or eight starts, he's kind of showed that he's still got Justin Verlander inside of him and I think tonight was a little bit of an exclamation point."
After little to no run support in the recent past, the Tigers gave Verlander all the offense he would need in the second inning, when Nick Castellanos hit a solo home run to left-centerfield for his 15th home run of the year. They padded the lead in the fifth inning when Miguel Cabrera hit his 17th, a two-run shot to left-centerfield, and Martinez hit his 34th, a two-run shot just inside the foul pole in leftfield two batters later.
"He had some trouble getting run support so he took matters into his own hands," Ausmus said.
And the results of the pitches that left his right hand were weak outs, easy outs, nine strikeouts – eight swinging – and only one hard hit out, from Mike Trout in the fourth inning, a line drive groundball that Jose Iglesias stabbed with a backhand before beating the speedy All-Star by two steps with a strong throw to first base.
In the seventh inning, he struck out Trout looking on a full-count curveball. In the eighth, he induced a double play from Aybar on a changeup.
And in the ninth, with thousands on their feet, Verlander was finally back to his best, where he feels he belongs, falling just short of his third no-hitter for the most in team history and joining an elite group of hurlers, but earning his seventh career shutout and first since 2012.
"It would be nice to be in that group, especially the names in there," Verlander said. "Anytime you can get in with Cy Young, that's pretty good."
Verlander previously threw no-hitters at home on June 12, 2007, against the Brewers and on the road on May 7, 2012, against the Blue Jays.
But after the eight no-hit innings, and after Iannetta's double to open the ninth, it felt like Comerica Park in 2012, when Verlander allowed a one-out single in the ninth inning to Pirates infielder Josh Harrison.
"Pittsburgh," he said, cutting off a reporter's question about that game. "It's always been something on my brain, I guess. When you get to three, the number of guys that have done it shrinks significantly."
And after his latest masterpiece, a vintage Verlander performance – a word he admittedly doesn't like – and after his last month of premier pitching – he has a 1.38 ERA in his past seven starts – it looks like he will get more chances to expand that club.
"I don't think this is a throwback," Verlander said recently. "This is the pitcher that I am."
And on this night, Justin Verlander, ace right-hander, was proved right.
Contact Anthony Fenech: afenech@freepress.com. Follow him on Twitter @anthonyfenech. Join us for a a live blog of the Tigers vs. Angels game on Thursday afternoon at freep.com/sports. Also check out our latest Tigers podcast at freep.com/tigerspodcast or on iTunes.
Lions offered Richard Sherman big money in 2018. Here's why he said no
Richard Sherman vs. Jim Harbaugh: 'I wanted to put him out' of NFL
The bat that Tigers need — and once had — now belongs to the Reds
Why so many ex-Lions are part of 49ers' Super Bowl run
Hall-of-Fame TE says Lions' T.J. Hockenson headed for 'outstanding career'
Wings mailbag: Why Yzerman backs coach Jeff Blashill


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SHERIDAN — The Sheridan College Symphonic Band will perform at 7 p.m. March 29 at the Whitney Center for the Arts. The concert is free and open to the public.
It will include a wide range of music including two student trumpet soloists — Rósborg Halldórsdóttir, a recent University of Wyoming Brass Performance Scholarship winner and Student of the Year, along with Sheridan's own Shane Carey.
For additional information, see whitneyarts.org. The Whitney Center for the Arts at Sheridan College is located at 1 Whitney Way.


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Q: How to assign a property in xaml to a variable inside another class? Lets say I have a usercontrol that is basically a button, set up in XAML. Would it be possible for that button to get its background color from a different usercontrol class in a different file, so that it is changeable during runtime?
All I found from google is talk on themes and how they all want to refer to a theme file or the main window but I didn't find either of them useful because for one, I wouldn't have the slightest idea on how to change the theme file during runtime (if its even possible) and second, I plan to use these controls I'm buildings in other projects too so i don't want them to rely on anything to do with the main window.

A: Use WPF's DynamicResource markup extension on the button's background colour, then you can change the resource, and thus  the theme dynamically at runtime.
See the Stackoverflow answer to WPF Dynamically change resource file and theme.

A: All of these explain things way too confusing while the answer is as simple as pie.
step1: add a resource directory file to your project and make your variables, something like
<SolidColorBrush x:Key="lsd" />

step2: add to each user control you want to access the resource
<UserControl.Resources>
    <ResourceDictionary Source="myResourceName.xaml"/>
</UserControl.Resources>

stel3: make something use the resource like
<Grid Background="{DynamicResource lsd}/>

step4: modify the variable in the resource in any of the affected controls by calling stuff like
Resources("lsd") = Brushes.Blue

step5: for additional hilarity add a sub like this to your control
Public Sub lsdMode() Handles Me.MouseMove
    Dim r As New Random
    Resources("sbL1") = New SolidColorBrush(Color.FromRgb(r.Next(255), r.Next(255), r.Next(255)))
End Sub


Sabrina is an absolute whiz at online business and social media marketing. She's helped me with my content and my Pinterest in ways that I never thought anyone could. Sabrina's work was the perfect mix of strategy and implementation and was exactly what I needed in my business. She also included my team in this process, which I was so delighted by. Sabrina swooped in, allowed my OBM to join us on our call, shared brilliant strategy, and set it all up.
My blog traffic from a measly 2,500 views per month to over 30,000 in just a few short weeks. I really couldn't believe it!
Sabrina's help was absolutely invaluable to my business! Her help with Pinterest alone boosted my blog traffic from a measly 2,500 views per month to over 30,000 in just a few short weeks. I really couldn't believe it!
If that wasn't enough, she worked tirelessly to help me raise my opt-in and conversion rates, successfully launch my courses to a small list, and basically grow my business faster than I ever could have. My business is where it's at today because of Sabrina's services!
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Working with Sabrina would be life-changing and set the wheels truly in motion for a transition you may only be flirting with. There are many amazing people from all over the world in her program whose growth stories I am now keenly following. We are sharing this experience together and growing together. Their struggles, successes and support inspire me to keep me going. I would absolutely recommend Sabrina.
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I've learned how to grow an audience, align my purpose with my gifts and messaging to get visible, attract soulmate clients, and all the techy how-to's of the practical side of managing a business. I am supported in literally all areas -- spiritually, mentally, strategically, and physically. I believe in myself, more and more every single day.
She is THE expert for me and working with Sabrina for a year would be LIFE-CHANGING. She attracts "movers and shakers" to her programs and that means super engaged, focused, supportive, and encouraging groups. The accountability and friendships I've developed have been so beneficial to my success and I am eternally grateful I found Sabrina. I sing Sabrina's name from the rooftops!
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Healthcare Quarterly 8(Sp) October 2005 : 81-85.doi:10.12927/hcq..17669
Inappropriate Prescribing Practices: The Challenge and Opportunity for Patient Safety
Laurel K. Taylor, Yuko Kawasumi, Gillian Bartlett and Robyn Tamblyn
Adverse clinical events related to inappropriate prescribing practices are an important threat to patient safety. Avoidance of inappropriate prescribing in community settings, where the majority of prescriptions are written, offers a major area of opportunity to improve quality of care and outcomes. Electronic medication order entry systems, with automated clinical risk screening and online alerting capabilities, appear as particularly promising enabling tools in such settings. The Medical Office of the Twenty First Century (MOXXI-III) research group is currently utilizing such a system that integrates identification of dosing errors, adverse drug interactions, drug-disease and allergy contraindications and potential toxicity or contraindications based on patient age.
This paper characterizes the spectrum of alerts in an urban community of care involving 28 physicians and 32 pharmacies. Over a consecutive nine-month period, alerts were generated in 29% of 22,419 prescriptions, resulting in revised prescriptions in 14% of the alert cases. Drug-disease contraindications were the most common driver of alerts, accounting for 41% of the total and resulting in revised prescriptions in 14% of cases. In contrast, potential dosing errors generated only 8% of all alerts, but resulted in revised prescriptions 23% of the time. Overall, online evidence-based screening and alerting around prescription of medications in a community setting demands confirmation in prescribers' clinical decision making in almost one-third of prescriptions and leads to changed decisions in up to one-quarter of some prescribing categories. Its ultimate determination of clinical relevance to patient safety may, however, have to await more detailed examination of physician response to alerts and patient outcomes as a primary measure of utility.
Patient safety is an increasingly recognized challenge and opportunity for stakeholders in improving health care delivery. It involves many issues, including delayed diagnosis and treatment, as well as inappropriate undertreatment and overtreatment. The common denominators, however, are that care and outcomes could be better, and there is a role for patients, providers and policy makers in making improvements.
Adverse events related to medication use are a leading cause of patient morbidity and mortality in North America (Lazarou et al. 1998). There are numerous contributing causes of the overall adverse event rates, including errors in dispensing, monitoring and adherence to medications (Avery et al. 2002). They may drive up to a quarter of all hospital admissions (Grymonpre et al. 1988; Hurwitz 1969; Ives et al. 1987; May et al. 1977), and this problem will likely be magnified by the increasing prevalence of chronic comorbidities in an increasingly aged population who also live in a culture of widespread over-the-counter medication use and acceptance of polypharmacy.
Changing the prescribing behaviour of physicians, particularly for complex aspects of care, can be a formidable challenge. Proven tools to facilitate recognition and closure of care gaps are few and even fewer offer a real time capability for matching problem identification to corrective action.
Recent work suggests that electronic prescription order entry systems with automated evidence-based risk-screening and alerting capabilities offer promise as tools in decreasing inappropriate prescribing patterns and related adverse clinical events (Bates et al. 1999; Bates et al. 2001; Bates et al. 2003; Bates and Gawande 2003; Kaushal and Bates 2002). At least theoretically, physicians consider an alerting system a worthwhile ingredient to improve prescribing safety (Ashworth 2002). However, despite the potential advantages offered by such tools, their effective acceptance and utilization has been slow (Aydin and Rice 1991; Bates and Gawande 2003; Tamblyn et al. 2003). Studies to assess why this is so have indicated several potential causes, including variable technical performance and the "back box" nature of some tools, which make it difficult to obtain reliable data to allow cause and effect analyses (Hazlet et al. 2001; Oren et al. 2003). Perhaps more importantly, there is also a physician perception of narrow clinical applicability, or inadequate general clinical relevance, of the parameters screened and alerts generated by these tools (Gurwitz et al. 2003; Hsieh et al. 2004; Monane et al. 1998).
One practical manifestation of this sense of clinical irrelevance is that physicians' frequently override, or ignore, drug alerts (Glassman et al. 2002; Magnus et al. 2002). This may also suggest an element of alert fatigue or information overload, further encouraging physicians to view alerts as a burden or hindrance to improving practice quality rather than as a decision support tool to improve quality of prescribing. If we are going to optimize the use of these systems to optimize patient safety, we need to understand four fundamental issues: the alerts these systems are producing, their clinical relevance, the physicians' response, and the reasons the physicians are responding in this manner. It is only with this information that we can improve the utility of these decision aids to reduce drug-related morbidity.
At this point, the purpose of this research was identify what alerts physicians are seeing in outpatient settings, to and to build a better understanding of their perceptions of the value of alert systems. We took advantage of a community-based trial to conduct a novel investigation of the type of drug-related alerts in primary care.
The Medical Office of the Twenty First Century (MOXXI-III) is a group of academic and community-based health care stakeholders interested in improving care and outcomes for patients. As part of the research program, this partnership has developed a comprehensive, evidence-based and integrated drug management system designed to reduce prescription errors. Briefly, the system provides an electronic prescription, drug and disease management system for primary care physicians, community-based pharmacists and their patients. It is unique in several ways. It has the ability to identify dosing errors, drug interactions and duplications, as well as possible drug-disease contraindications, drug-allergy reactions, potential toxicity and contraindications due to patient age. The system also electronically documents the clinical rationale used by the physician in prescribing decisions at the point-of-care, including starting, stopping and renewing medications and response to drug alerts.
Participating physicians utilize a personal digital assistant (PDA) that includes a dynamic prescription pad that displays treatment indications and allows participating pharmacies to electronically retrieve the prescription. The content for the electronic prescription drug alerts was provided by Vigilance Santé Inc. via their Rx Vigilance therapeutic advisor. A drug profiler on the PDA allows the physician to view a graphic representation of each patient's prescription medication(s) for the prior 12 months, including drugs prescribed by other physicians via access to linked data from the provincial health database. The PDA alert system also flags drug interactions, therapeutic duplications, contraindications for specific allergies or diseases and verifies drug dosage against the base of continually updated evidence for these variables. A specific message is automatically generated on the PDA providing a summary of the situation and allowing the physician to respond in an autonomous manner. The physician's response to the alert is also captured in the system.
The MOXXI approach to assessing prescription-associated errors has been undergoing pilot testing in representative communities of care. One project was carried out in the West Island area of Montreal and involved 28 community physicians, 32 community pharmacies and approximately 12,500 patients between June 2003 and February 2004. The primary purpose was to gain an overview of the prevalence of prescribing problems, by type of prescribing error and disease and therapeutic category, in a large community care setting. A subsidiary purpose was to develop a sense of the clinical relevance of such data, particularly as it was used by physicians to alter their decision making. The early findings of this project are summarized below.
During a nine-month period, a total of 6,428 alerts were generated by 22,419 prescriptions, an overall alert rate of 29%. The overall revision rate (prescriptions revised on the basis of alert information received) on the alerted prescriptions was 14%. Six categories of potential error or inappropriateness accounted for 99% of the alerts. They were: drug-disease contraindication; drug duplication; drug-drug interaction; toxicity; dosing error; and age-related contraindications, displayed in Table 1. Drug-disease contraindications generated the greatest number of alerts; dosing errors, the least. However, dosing errors drove the highest rate of prescription revisions, 23%. Interestingly, age-related alerts were both infrequent and low drivers of revision.
The most prevalent drug classes associated with alert generation for each of the prescribing error categories are displayed in Table 2. Antidepressants were the most frequently involved class of drugs, accounting for 13% of all alerts and making the top three list of prevalence in five of the six alert categories (Table 2). A close second was the nonsteroidal anti-inflammatory drug class (NSAIDs), underlying 12% of all alerts and making the top three list for three alert categories.
In the drug-disease contraindication alert category, the top three medication classes (NSAIDs, thyroid replacements and antidepressants) generated 47% of all the alerts. Thirty percent of the alerts were triggered by a contraindication due to the presence of asthma, while 66% were associated with underlying hypertension. The presence of cardiovascular disorders was associated with 99% of the alerts for thyroid replacement therapy. Likewise, 82% of the warning messages that physicians received for antidepressant medication flagged a possible contraindication due to the presence of a cardiovascular disorder.
HMG-CoA reductase inhibitors led the drug-drug interaction category of alerts, the majority flagged because of concern over concomitant use with calcium channel blockers (47%). In the case of beta-blockers, 17% of the drug-drug interaction alerts involved potentially negative interaction with an antidepressant medication, while 14% involved an alpha or beta agonist. Insulin was implicated in 29% of the interactions with an NSAID, with sulfonylurea agents involved in 26%.
Potential toxicity was principally associated with antidepressant therapy, alerts warning of potential arrhythmias in 69% of the cases and of sedation in 31%. ACE inhibitors were associated with the potential for hyperkalemia in all cases, while benzodiazepines generated a warning of potential sedation in all cases. Antidepressants and benzodiazepines accounted for 58% of potentially inappropriate prescriptions among the older age patients.
Potential dosing errors resulted in messages that alerted the prescribing physician that an initially prescribed medication dose was either too high or too low. All alerts associated with antidepressants and thyroid agents suggested too-high doses, while medications that required prior authorization by the prescribing physician warned of doses being too low.
The View Going Forward
In summary, automated online medication screening and risk alerting appears to have significant potential to reduce inappropriate prescribing practices and improve patient outcomes.
The MOXXI III evidence-based system used in the commun-ity based general practice setting demanded confirmation in prescribers' clinical decision making for almost one-third of prescriptions and led to changes in ultimate prescribing decisions about 14% of the time, overall, but up to one-quarter of the cases in some prescribing categories; for example, dosing level.
A potential weakness of all current alert systems, however, is that they address only part of the problems facing the prescribing physician in the real-world primary care setting. Each patient presents a unique set of clinical conditions and risks that the physician must incorporate into treatment decisions. For example, antidepressants are among the most frequently dispensed drugs in Canada and the most common alert-generating medication. As well, they are among the four most frequently involved classes of medication implicated in adverse drug events in malpractice claims (Rothschild et al. 2002). Risk of adverse events from antidepressants increases as patient's age and the number of comorbid diseases and associated coprescriptions increase. But in an individual patient all of these factors may be counterbalanced by some other risk-reducing factor, like the patient whose genetically determined drug metabolism is more rapid. Current automatic alert systems are not refined enough to take these patient-specific characteristics into account. If the failure to account for these clinical conditions produces many false positive alerts, physicians will be overloaded with information and be unlikely to respond to true high-risk safety situations. This issue is not easily addressed. Current systems make an effort to reduce false positives by instituting modifiable severity alert levels, as is the case with the MOXXI system. However, these classifications are based on theoretical risk, low-levels of empirical evidence, and fail to consider patient-specific risk profiles.
Thus, what these systems don't do is identify and relay information that allows the physician to assess the balanced level of total risk, and they cannot, at the present time, remove the need for, and value of, clinical judgment. Finding the best criteria for alert threshold that provides a high degree of certainty that a positive alert is truly positive in the sense it truly identifies risk requiring action will require more study and investigation in multiple clinical settings. Nonetheless, the MOXXI III results suggest that the system, even with its current sensitivity and positive predictive value characteristics, may be seen as providing a measure of clinically relevant assistance for prescription decision making and lend itself to widespread adoption in general practice settings with modifications based on further analysis.
Its ultimate determination of clinical relevance to patient safety may, however, have to await the results of other studies, particularly randomized clinical trials, with patient outcomes as the primary measure.
Laurel K. Taylor, PhD, is a Postdoctoral Fellow in the Department of Medicine, McGill University, QC.
Yuko Kawasumi, MSc, is a PhD Candidate in the Department of Epidemiology and Biostatistics, McGill University, QC.
Gillian Bartlett, PhD, is an Assistant Professor in the Department of Medicine and an FRSQ funded Chercheur-Boursier.
Robyn Tamblyn, PhD, is a Professor in the Department of Medicine and the Department of Epidemiology and Biostatistics at McGill University, Faculty of Medicine. She is a Canadian Institutes of Health Research (CIHR) scientist and a McGill University William-Dawson scholar. She also holds a position as Medical Scientist at the McGill University Health Center Research Institute.
Corresponding Author: Laurel K. Taylor, PhD, Clinical and Health Informatics Research Group, McGill University, 1140 Pine Avenue West, Montreal, Quebec, H3A 1A3, Canada., Tel: (514) 934-1934 ext. 32968; Fax: (514) 843-1551; Email: laurel.taylor@mcgill.ca
The authors gratefully acknowledge the MOXXI-III project team for their assistance and support. This project is supported by Canadian Institutes of Health Research (CIHR), Canada Health and the Canada Health Infostructure Partnerships Program (CHIPP).
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Revisiting a Book Review: How Economics Shapes Science by Paula Stephan
By Kent Anderson
Social Role
Editor's Note: Given the significant impression that keynote speaker Paula Stephan made at this year's Society for Scholarly Publishing Annual Meeting, I wasn't sure if attendees were aware of this pair of Kent Anderson posts from 2012, a review of Stephan's book on the economics of scientific research and (re-running tomorrow) an interview with Stephan. Although the posts are now more than five years old, the economic conditions described have only accelerated.
I recently finished a very interesting and useful book entitled, "How Economics Shapes Science," written by the economist Paula Stephan (Professor of Economics, Georgia State University and a member of the National Bureau of Economic Research). Stephan is an economist who accidentally became an expert in science economics, a little vignette that sets a nice tone for the book, which is superb overall — well-written, smartly structured, and well-referenced. In fact, for the serious reader, I'd recommend ordering it in print because the ability to flip back and forth between the nicely designed and very usable notes pages and the main text is vital to enjoying the book.
While the topic is of inherent interest to anyone working in the sciences, Stephan also touches on many points of particular interest to publishers, including why authors publish and related issues.
Stephan's main point is that while the information emanating from research activities is itself hard to take to market — it is non-rival and non-excludable — the economic units of value to scientists are prestige and priority. These aren't new ideas at all, but Stephan is able to bring data together to underscore how vital the incentives of prestige and priority are — they determine what happens to scientists, from lab space to letterhead.
There are many interesting themes in the book, from the way university research changed with the 1982 Bayh-Dole Act (which gave universities new control of patents and other IP emanating from federally funded research), to the proliferation of prize-based science, to the growth of the mega-foundations like HHMI and Wellcome, to the sometimes dramatic effects funding decisions can have, both when it grows and when it shrinks.
Perhaps the most interesting story in this story-packed book is the tale of the years 1998-2002, when the NIH budget doubled. This vast influx of funding had many unanticipated and some unproductive outcomes:
Success rates for R01 grant applications didn't rise, and in fact fell significantly by 2009
Universities used the funding to justify a building binge, partly to lure prime faculty and partly to create capacity for the anticipated grants
Grants grew in size, and absorbed more costs, like graduate student tuitions and other overheads
The short-term nature of the doubling, combined with the long-term nature of the resulting grant commitments, created a dearth of money in subsequent years, as funding fell yet remained tied to previous commitments
The NIH took monies away from R01 grant-making during the expansion to pursue other, larger initiatives
Younger researchers suffered more, as renewing grants did better overall during both the funding boom and the subsequent cuts
The number of papers resulting from the doubling of NIH funding remained stubbornly unaffected — as one study put it, "Wherever the funds went, they left no clear scientific record."
This is the kind of rich, data-driven, and nuanced discussion of science and economics readers can expect throughout Stephan's excellent book.
Stephan addresses how R&D spending is often driven by politics — either geo-politics (the Cold War) or personal politics (biomedical research), and how jobs in the sciences respond accordingly (and how competitive options for smart people have affected job uptake). She also talks about how difficult science and research spending is to measure from an economic efficiency perspective — essentially, because payback on investments can be quite indirect and take decades, choosing between investment options is fraught with the chance for mistakes. And the emerging trend showing that higher-impact science comes from funding entities that evaluate people instead of projects and provides longer-term funding is also covered.
Many of the studies Stephan had to work with are dated, unfortunately, suggesting strongly that we need to do more (and more current) studies of these issues. It's clear that economics shapes science. This becomes clearest at the end of the book, in a chapter entitled, "Can We Do Better?". Here, Stephan writes sentences that bristle a bit:
In many ways universities in the United States behave as though they are high-end shopping malls. . . . faculty "pay" for the opportunity of working at the university, receiving no guarantee of income if they fail to bring in a grant. . . . The system that has evolved discourages faculty from pursuing research with uncertain outcomes. . . . The current university research system in the United States also discourages research that could disprove theories.
This book will have a special place on my shelf, as one of a handful of books that demand to be revisited, referenced, and re-read because there is so much clear and important information to be had, and some definite criticisms of the current system policy-makers need to consider.
@kanderson
Kent Anderson is the CEO of RedLink and RedLink Network, a past-President of SSP, and the founder of the Scholarly Kitchen. He has worked as Publisher at AAAS/Science, CEO/Publisher of JBJS, Inc., a publishing executive at the Massachusetts Medical Society, Publishing Director of the New England Journal of Medicine, and Director of Medical Journals at the American Academy of Pediatrics. Opinions on social media or blogs are his own.
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1 Thought on "Revisiting a Book Review: How Economics Shapes Science by Paula Stephan"
Yes, indeed, research spending is driven by politics. Battling post-truth tendencies, the Director of the NIH, albeit ephemerally, recently pondered the notion of a cutoff in maximum funding for "leading" researchers. He seems to have recalled the truths long ago advanced by Erwin Chargaff 's "In Praise of Smallness" , that research productivity is not a linear function of grant dollars allocated. Although difficult to precisely quantify, numerical evidence, similar to that which influenced the Director, was made available by David Currie as the "Law of Diminishing Returns" in the Canadian journal University Affairs (Jan 2010; pp. 26-27) and in Nature (2009; 461, 1198). Michael Lauer has recently provided further data.
Sadly the Director soon changed his mind. While many "leading" scientists do great work and can justify every dollar their laboratories receive, anyone who has read Thomas Soderqvist's biography of Niels Jerne, or the "The Network Collective" by Klaus Eichmann (2008), knows that too often the "Trumps" of science win out over the scientific "Clintons." Hopes for light at the end of the tunnel continue to dwindling!
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